Provider Demographics
NPI:1225859135
Name:LONG, JOCELYN KATE
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:KATE
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2462 GLENARM PL APT D
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3174
Mailing Address - Country:US
Mailing Address - Phone:978-502-1948
Mailing Address - Fax:
Practice Address - Street 1:225 W SOUTH BOULDER RD STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1194
Practice Address - Country:US
Practice Address - Phone:720-868-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health